Background: Recalcitrant lateral epicondylitis (LE) is a common debilitating condition with numerous treatment options of varying success. Injection of platelet-rich plasma (PRP) has been shown to improve LE, although it is unclear if the method of needling used in conjunction with PRP injection is of clinical importance.

Purpose: To determine if percutaneous needle tenotomy is superior to percutaneous needle fenestration when each is combined with PRP injection for the treatment of

Conclusion: PRP injection with concomitant percutaneous needling is an effective treatment for recalcitrant LE, with sustained improvements in pain, strength and function demonstrated at average follow-up of greater than 3 years. Although the method of concomitant needling does not appear to have a significant effect on treatment outcomes, more aggressive needle tenotomy is less likely to require conversion to open tenotomy than needle fenestration in the short-to-midterm.